Role of attentional focus in pain perception: manipulation of response to noxious stimulation by instructions.
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Adolescent↗
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Health perception, pain, and disability as correlates of anxiety and depression symptoms in primary care patients.
BACKGROUND: Anxiety and depression occur frequently, and recognition of their symptoms can be difficult because of comorbid medical conditions. The purpose of this study was to analyze the relations among symptoms, diagnoses, and severity of illness as indicators of anxiety and depression in primary care. METHODS: This was an observational, cross-sectional study of adult patients in a large, academic family medicine clinic. Patients completed the Duke Health Profile, which measures health-related quality of life and screens for anxiety and depression. Providers recorded patient diagnoses and assessed severity of illness. RESULTS: Patients with higher levels of anxiety and depression symptoms were more likely to have the diagnoses of headache, osteoarthritis, abdominal pain, and diabetes mellitus. These diagnoses, however, were no longer highly associated with anxiety and depression after controlling for age, sex, payer status, perceived health, pain, and disability. The indicators of high anxiety and depression symptom levels that persisted after controlling for all the other variables were female sex, low perceived health, more pain, and greater disability. CONCLUSION: In a primary care setting, female sex, self-reported perceived health, pain, and disability were more predictive of anxiety and depression than any of the most prevalent medical illnesses. Primary care providers need to be knowledgeable about these health measures so they can recognize patients at risk for anxiety and depression regardless of their medical diagnoses.
Adolescent↗
Acute low back pain: patients' perceptions of pain four weeks after initial diagnosis and treatment in general practice.
In a nationwide study of the treatment of acute low back pain with and without radiation in general practice in the Netherlands the subjective well-being of patients was evaluated by means of a short questionnaire sent to patients four weeks after the initial contact with their general practitioner.After this period pain had disappeared in 28% of the patients, was diminished in 47%, was unchanged in 2% and was aggravated in 4%. There was no difference in the pain score of patients with and without follow-up encounters with their general practitioner. In all instances patients with low back pain without radiation fared significantly better than those with radiation. Radiation of pain was not constant - during the four-week follow-up period it developed in 19% of the patients originally without radiation and it disappeared in 44% of the patients originally suffering radiation.
Acute Disease↗
Effect of electroacupuncture on the pain perception threshold of human teeth.
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Acupuncture Therapy↗
Is there a role for the parietal lobes in the perception of pain?
Converging lines of evidence confirm a role for the anterior parietal cortex in pain processing and extend the traditional view of SI to include discriminative aspects of somatic stimulation that is potentially tissue-damaging (e.g., painful). Recent studies more specifically implicate SI in the sensory aspect of pain perception by demonstrating that SI activation is modulated by cognitive manipulations that alter perceived pain intensity, but not by manipulations that alter unpleasantness, independent of pain intensity. Nevertheless, despite the probable role of SI in the encoding of the various sensory features of pain, considerable evidence suggests that nociceptive input to SI may also serve to modulate tactile perception. Thus, SI cortex may be involved in both the perception and modulation of both painful and nonpainful somatosensory sensations. Defining a role in pain processing for the parietal operculum is somewhat more problematic. The absence of a fine somatotopic organization of cutaneous (or visceral) receptors virtually eliminates a substantial role for this region in localizing noxious stimuli. Several studies suggest separate representations for pain and touch within the posterior parietal cortex and SII, respectively; however, inter-species differences in cortical anatomy and inconsistencies in the designation of SII proper preclude a clear reconciliation of the data. Likewise, suggestions that SII activation is predominantly related to processing the nociceptive quality of the stimulus (60,61) are inconsistent with many studies in both human and nonhuman subjects, which show a strong functional relationship between SII activity and innocuous (especially, vibrotactile) stimulation. Nevertheless, the numerous studies indicating pain-related activation within the parietal operculum (and/or SII) underscore the potential importance of this region in the perception of pain and the need for continued research. Finally, a possible role of posterior parietal cortex (BA 5/7, 39/40) in orientation and attention toward painful sensory stimuli is consistent with existing literature describing this region as a poly modal association area concerned with intrapersonal and extrapersonal space; however, results from studies that actually manipulate the subjects' level of attention relative to painful stimuli have not uniformly supported this hypothesis (75). Future studies assessing both attentional demand and direct manipulation or motor interactions involving noxious stimuli may help to resolve this issue. In spite of some discrepant results concerning specific details of the nociceptive process, the weight of human pain research now firmly establishes a role for the parietal lobes in the conscious appreciation of the sensation of pain.
Animals↗
Gender, coping and the perception of pain.
Research consistently indicates that gender differences exist in pain perception, with females typically reporting more negative responses to pain than males. It also seems as if males and females use and benefit from different coping strategies when under stress; females seem to prefer emotion-focused coping, whereas males prefer sensory-focused coping. Unfortunately, experimental research that examines such differences in the context of pain has not yet been adequately investigated. The aim of the current study was, therefore, to determine whether gender differences would be found in the effect that sensory-focused and emotion-focused coping instructions have on cold pressor pain experiences. Participants consisted of 24 male and 26 female healthy adults, all of whom reported no current pain. A consistent pattern of effects was found, over both behavioural and self-report measures of pain. Compared to females, males exhibited less negative pain responses when focusing on the sensory component of pain (i.e. increased threshold, tolerance and lower sensory pain). Furthermore, compared to sensory focusing, emotional focusing was found to increase the affective pain experience of females. Together these results confirm that important differences exist between men and women in the effects pain coping instructions have on the experience of pain. The implications of such findings for research and practice are discussed.
Adaptation, Psychological↗
Perception of pain after resistance exercise.
OBJECTIVES: The main objective was to assess the influence of resistance exercise on pain threshold and pain ratings. Secondary objectives included measuring state anxiety, body awareness, systolic blood pressure, diastolic blood pressure, and heart rate responses. METHODS: Pressure (3 kg force) was applied to the middle digit of the left hand for two minutes using a Forgione-Barber pain stimulator before and after (five minute and 15 minutes) resistance exercise and quiet rest. Resistance exercise consisted of 45 minutes of lifting three sets of 10 repetitions at 75% of an individual's one repetition maximum. Quiet rest consisted of sitting quietly in a room free from distractions. RESULTS: Data were analysed by repeated measures analysis of variance for multifactor experiments. Pain threshold was significantly higher (p<0.05) and pain ratings were significantly lower (p<0.05) five minutes after resistance exercise. Changes in pain perception were accompanied by changes in heart rate, systolic blood pressure, and body awareness after exercise. CONCLUSION: A single bout of resistance exercise is capable of modifying the sensation of experimentally induced pain.
Adult↗
The use of pain drawings in screening for psychological involvement in complaints of low-back pain.
The pain drawings of 54 low-back-pain patients were examined to find out if it is possible to use them as a brief screening test in order to assess the psychological impairment of the patients. We were using the scoring system of Ransford et al, which we slightly changed, and chose as a criterion variable the ERMSS (Erweiterte Revidierte Mehrdimensionale Schmerzskala) of Cziske. This test originates in the McGill Pain Questionnaire of Melzack and Torgerson; its scales describe four dimensions of pain perception: pain intensity, the sensory-discriminative dimension reflecting the somatic aspect of pain; the affective-motivational dimension, and the total number of words, both representing the psychological involvement of a pain patient. A correlation was found between pain drawing score and the sensory-discriminative dimension of pain perception, whereas there was no such correlation between drawing score and the affective dimension. These results indicate that the pain drawing score might not be a sufficiently valid instrument for assessing psychological disturbances in pain patients to allow it to be used for individual diagnosis without hesitation.
Adult↗
Examination of the Role of the Cerebral Cortex in the Perception of Pain Using Functional Magnetic Resonance Imaging.
In the following review we outline several of the unique difficulties associated with designing and interpreting functional imaging studies of pain perception. Unlike other sensory modalities, the cortical processing of pain is unique, as is the pain experience itself. Unlike other sensory systems, pain processing does not take place in one dedicated region of the cortex. Rather, nociceptive cells are sparsely distributed through the somatosensory cortex. Further, pain is singular in that it has both sensory-discriminative and affective-motivational components, which are probably subserved by different neuroanatomic substrates. Finally, abnormal pain sensation, such as neuropathic pain syndromes, may have different or additional mechanisms that require special consideration. We have illustrated these points with examples from our own work on acute pain and secondary mechanical hyperalgesia, and work from other laboratories.
Journal Article↗
Perceptions of pain in women with headache: a laboratory investigation of the influence of pain-related anxiety and fear.
The present study compared the responses of women with headache (chronic tension-type, n = 27; migraine, n = 27) and controls (n = 27) to an acute pain laboratory task, the cold pressor test. Participants' pain perception (i.e., threshold and tolerance) and their fear/anxiety associated with pain were assessed during days 1, 2, or 3 of menses. Analyses pertaining to participants' responses to the cold pressor test (ie, pain threshold and tolerance) failed to show statistically significant group differences, even when covarying pain-related anxiety/fear. Analyses did, however, reveal significant group differences between migraineurs and controls in cognitive anxiety. Correlational analyses also revealed that cognitive anxiety, somatic anxiety, fear, and escape/avoidance were all significantly correlated with pain tolerance in the group with chronic tension-type headache, but not in the other two groups. Subsequent multiple regressions, however, showed that the relationship between anxiety and pain tolerance was primarily a function of somatic anxiety. These results suggest that headache frequency plays a role in mediating the relationship between fear of pain and pain tolerance and that the models by Lethem and colleagues and McCracken may be relevant for understanding tension headache sufferers' responses to head pain.
Adult↗
Gender, interpersonal transactions, and the perception of pain: an experimental analysis.
UNLABELLED: Two experiments assessed how interpersonal transactions influence responses to cold pressor pain in women versus men. In Experiment 1, 91 young adults (57 women, 34 men) were randomly assigned to either a no transaction (NT) condition in which they coped alone with the cold pressor test or a transaction opportunity (TO) condition in which they also had the option of interacting with an empathetic, reflecting experimenter. Compared to men, women had lower pain tolerance and reported more pain and catastrophizing, although there were no gender differences in support seeking or other ways of coping. Within the TO condition, women were no more likely than men to initiate a transaction, but female speakers were more pain-focused than male speakers, and speaking with the empathetic interaction partner had generally negative effects on pain perception and coping. In Experiment 2, 126 young adults (76 women, 50 men) were randomly assigned to NT, TO, or experimenter-directed (1) Distraction (DT), (2) Reinterpretation (RT), or (3) Encouragement (ET) conditions. Although men had similar levels of pain tolerance across the 5 transaction conditions, women in NT and TO conditions exhibited reduced tolerance compared with those in the DT, RT, and ET conditions. Pain tolerance times among women in DT, RT, and ET conditions were equal to or exceeded those of men in these conditions. Together, findings suggest the nature of interpersonal transactions exerts a greater influence on women's responses to noxious stimulation than those of men. PERSPECTIVE: This study adds to literature indicating that women exhibit reduced tolerance for experimentally induced pain compared with men. These results suggest that the nature of interpersonal transactions also affects women's responses to noxious stimulation, more than those of men.
Adolescent↗
Reduced perception of pain in schizophrenia: its relevance to the clinical diagnosis of compartment syndrome.
An atypical presentation of compartment syndrome is reported in a chronic schizophrenic patient with a closed upper tibial fracture. The features of this case and a review of the literature pertaining to pain perception in this group of patients are presented to raise clinical awareness of this combination of disorders, which may lead to delayed treatment of a surgical emergency, consequent on lack of development of classic symptoms in these patients. We suggest continuous intracompartmental pressure monitoring, even in awake schizophrenic patients with injuries at risk of compartment syndrome.
Compartment Syndromes↗
Enhancement of the perception of systemic pain in women with vulvar vestibulitis.
OBJECTIVE: The aim of this study was to determine whether the characteristics of systemic pain perception and anxiety differ between women with vulvar vestibulitis and healthy women. DESIGN: Case control study. SETTING: Tertiary care hospital. POPULATION: Forty-four women with vulvar vestibulitis and 41 healthy women participated in the study. METHODS: First, the women's state and trait anxiety was evaluated. Thereafer, heat pain stimuli were applied to the women's forearm and the pain and unpleasantness thresholds, as well as magnitude estimation of perceived intensity and unpleasantness of suprathreshold stimuli, were assessed. Finally, blood pressure was measured before, during and after a heat stimulus of 46 degrees C. MAIN OUTCOME MEASURES: Pain threshold and suprathreshold, and anxiety levels of women with vulvar vestibulitis. RESULTS: Women with vulvar vestibulitis had a higher anxiety state (40.0 [12.8] vs 34.1 [10.8], P = 0.044), a higher anxiety trait (42.1 [10.2] vs 35.6 [7.5], P = 0.005), a lower pain threshold (42.2 degrees C [2.5] vs 43.6 degrees C [1.9], P = 0.006), a lower unpleasantness threshold (40.2 degrees C [2.9] vs 41.7 degrees C [2.3], P = 0.023), a higher magnitude estimation of suprathreshold pain at 47 degrees C (88.3 [14.9] vs 70.8 [14.9], P = 0.0001) and at 48 degrees C (96.1 [7.3] vs 84.6 [14.8], P < 0.0001), a higher scoring of tonic pain perception (65.2 [17.3] vs 53.0 [18.6], P = 0.006) and a higher increase in systolic blood pressure during tonic pain stimuli (4.6 [9.6] vs -2.1 [8.7] mmHg, P = 0.005). CONCLUSION: Women with vulvar vestibulitis have an enhanced systemic pain perception and are more anxious.
Adult↗
Effects of physical activity on maternal plasma beta-endorphin levels and perception of labor pain.
Thirty-six women in their second or third pregnancies were studied in two groups (control and exercise) to determine whether plasma alpha-endorphin levels could be elevated by exercise conditioning during pregnancy. Aerobic training was performed on a bicycle ergometer. Both groups were monitored throughout pregnancy by frequent gynecologic examinations. During labor, both groups of women had pain perception assessment. Blood was sampled for levels of beta-endorphin, cortisol, human growth hormone, and prolactin. Plasma beta-endorphin was found elevated compared to controls in patients who exercised throughout pregnancy. This difference was maintained throughout labor and pain perception during labor was reduced in the patients who exercised. Cortisol, human growth hormone, and prolactin levels were lowered during labor for the exercise-conditioned patients. Exercise conditioning during pregnancy seems to be beneficial in reducing pain perception during labor (as determined by measurement of visual analog pain scales) and in reducing stress levels during labor.
Arm↗
Gender differences in the perception of chest pain.
This study investigated gender differences in pain perception as characterized by pain symptoms in patients diagnosed with unstable angina pectoris. Twenty-nine women and 32 men were asked to characterize their chest pain using a semi-open questionnaire assessing pain intensity (by numerical rating), pain location, pain characteristics, complaints following chest pain, factors that evoked or reduced chest pain, and whether the chest pain was related to heart disease. Significant gender differences were found. Women scored the intensity of their chest pain significantly higher than men (Chi-square 14.8, P < 0.0001), and related their chest pain less to heart disease (Chi-square 24.6, P < 0.0001). The women described an atypical clinical picture of chest pain that was significantly different from men's. The results are discussed in light of pschological theories regarding gender differences in pain perception. These findings imply the need for special attention to the unique clinical pictures that appear for women and men.
Aged↗
Perception of pulpal pain as a function of intradental nerve activity.
The purpose of the present investigation was to find neurophysiological correlates of pain perception. The magnitude and time course of perceived pain was successfully related to the neural discharge evoked by rapid cooling of the tooth surface in 6 dental patients whose lower incisors were to be extracted for prosthodontic reasons. Two cavities were prepared on the facial surface of human lower incisors. The cavities were deepened using hand driven instruments until the pulp was visible through a thin layer of dentin. A metal tube was placed in contact with amalgam on each cavity bottom and fixed in place by composite filling material. The tubes were connected to standard equipment for electrophysiological recordings by a flexible circuit. The magnitude of perceived pain was assessed by a cross-modality matching to finger span in combination with sensory verbal pain descriptors and magnitude estimation. The striking agreement between the integrated nerve activity, probably of the A delta type and pain perception, is of great importance from the methodological point of view since it strongly argues in favor of the appropriateness of the techniques applied here to elucidate the neural substrate of some types of nociception and also to evaluate various means of relieving such pain.
Adult↗
The use of therapeutic massage as a nursing intervention to modify anxiety and the perception of cancer pain.
The purpose of this exploratory study was to examine the effects of therapeutic massage (consisting of effleurage, petrissage, and myofascial trigger point therapy) on pain perception, anxiety, and relaxation levels in hospitalized patients experiencing significant cancer pain. Thirty minutes of therapeutic massage was administered on two consecutive evenings to nine hospitalized males diagnosed with cancer and experiencing cancer pain. The subjects' self-reports of pain and relaxation (measured by Visual Analogue Scales) as well as anxiety (measured by the Spielberger State Anxiety Inventory) were recorded before and immediately after the intervention. The objective physiologic measures of heart rate, respiratory rate, and blood pressure were obtained before, immediately after, and, finally, 10 min after the massage intervention. Massage therapy significantly reduced the subjects' level of pain perception (average = 60%) and anxiety (average = 24%) while enhancing their feelings of relaxation by an average of 58%. In addition to these subjective measures, all physiological measures (heart rate, respiratory rate, and blood pressure) tended to decrease from baseline, providing further indication of relaxation. In conclusion, although the exact mechanism is not known, therapeutic massage is a beneficial nursing intervention that promotes relaxation and alleviates the perception of pain and anxiety in hospitalized cancer patients.
Adult↗
Diffuse noxious inhibitory controls (DNICs): psychophysical evidence in man for intersegmental suppression of noxious heat perception by cold pressor pain.
Counterirritation, the phenomenon of one painful stimulus reducing pain caused by a second noxious stimulus, has been recognized clinically for decades. Recently a physiological mechanism to explain counterirritation was described and termed diffuse noxious inhibitory controls (DNICs). Nevertheless, few psychophysical studies have examined systematically the effects of a noxious conditioning stimulus on pain perception. The present study examined the perception of painful heat stimuli on the face before, during and after the subject submerged a hand in painfully cold water (5 degrees C) for 5 min (cold pressor pain). We found that the subjects' ratings of the heat stimuli were significantly, although not completely, reduced during the cold pressor pain; this attenuation of pain perception continued after the noxious conditioning stimulus was withdrawn. Similarly, the pain threshold was significantly increased from 45.7 degrees C to 47.3 degrees C while the hand was in cold water and this threshold remained elevated after the cold water was terminated. Since DNICs have been found to completely and selectively inhibit the activity of only one type of pain transmission neuron (wide dynamic range), our data suggest that these neurons are involved in the perception of pain intensity. However, the persistence of residual pain perception in the presence of noxious conditioning stimuli indicates the importance of other nociceptive pathways.
Adult↗